Emotions and worries during 1.5 years of the COVID-19 pandemic - how adults with and without mental health conditions coped with the crisis

Background During the COVID 19 pandemic, there were social restrictions with severe mental stress for a long time. Most studies on mental health consequences of the pandemic focused primarily on the beginning of the pandemic. The present study on families of patients or study participants of a child and adolescent psychiatry aimed to examine long-term profiles of emotions and worries in adults with and without mental health condition (mhc) during the first 1.5 years of the COVID-19 pandemic. Methods We surveyed emotions and worries of 128 adults with (n = 32) and without (n = 96) pre-pandemic mhc over a 1.5-year study period from spring 2020 until summer/autumn 2021. Emotions and worries were captured at four time points: [i] pre-pandemic, [ii] spring 2020 (first lockdown was implemented), [iii] December 2020 (hard lockdown at Christmas time) and [iv] summer/autumn 2021 (considerable ease of regulations); [i] pre-pandemic and [iii] December 2020 were measured retrospectively). First, we run non-parametric tests to compare emotions and worries between adults with and without pre-pandemic mhc at the four time points. Next, we conducted latent profile analysis to identify subgroups from the total sample who share similar trajectories of emotions and worries. Finally, a logistic regression analysis was run to examine whether socio-demographic and psycho-social factors were related to identified trajectories of emotions and worries. Results Adults without pre-pandemic mhc reported a strong worsening of emotions and worries at the beginning of the pandemic and a lower worsening during the course, while adults with pre-pandemic mhc reported a constant worsening of emotions and worries. The latent profile analysis revealed three profiles of adults who show either i) an adaption, ii) no adaption or iii) a continuous high condition. With increasing age, higher perceived stress and pre-pandemic mhc, the likelihood of an adaption was increased. Conclusion The results of the present study suggested that adults (both with and without pre-pandemic mhc) coped the crisis with different strategies and that most of them returned to their initial, pre-pandemic levels of emotions and worries when social restrictions were considerably eased or stopped. Supplementary Information The online version contains supplementary material available at 10.1186/s12888-024-05573-x.


Situation in Germany during data collection
Spring 2020 (retrospective pre-pandemic inquiry and T1 data collection) The first lockdown was implemented on March 20 th , supposedly lasting for two weeks but was prolonged for another two weeks until April 20 th .During this time only shops of everyday needs were allowed to open, and the first curfews were imposed, restricting social contacts and scope of movement.
It is important to mention that most employees had to work from home while simultaneously child daycare-centers (kindergarten, schools etc.) were being closed.Aggravatingly, staying outside was forbidden except for taking a walk or a jog within a specified radius (playgrounds were closed).

December 2020 (retrospective inquiry T2)
During the summer period the amount of (daily) cases reduced significantly, hence social restrictions were eased.Social life went almost back to normal.In autumn incidences started rising again, resulting in a new partial lockdown at the beginning of November (02/11/2020) and a "hard lockdown" in December with even more social restrictions being imposed in order to prevent infection spread.All cultural and social facilities (e.g., restaurants, bars, clubs) were being closed, as well as shopping facilities that did not concern daily needs (e.g., clothing stores).Social gatherings were being restricted -per household only one additional person was allowed (a total of five persons was not to be exceeded).A curfew prohibited leaving home between 10 pm and 6 am (exceptions: e.g., professional obligations).
Additionally, schools and kindergarten were closed again.Schools first announced early Christmas holidays and then changed to a model where online and real-life classes rotated.The second lockdown additionally took place during a crucial point of time, due to the importance of the Christmas period in Germany which is normally a time of frequent social gatherings and events and were restricted vigorously over the Christmas holidays.That is important to mention as social rituals and events are shown to increase wellbeing and life satisfaction [1].On the other hand, Christmas often is associated with higher levels of loneliness and reduced emotional wellbeing especially in those suffering from mental health illnesses [2,3].

Summer/ autumn 2021 (T3 data collection)
In contrast, the situation during summer and autumn 2021 (July 16 th -October 25 th ) was less restricted.The vaccination campaign had made tremendous progress over the past couple of months, resulting in 67% of the German population that had been already fully vaccinated (October 22 nd ).In July, August and September 7-day incidences in Saxony had been rather small (July: < 10; August: < 20; September: up until 50) for a few weeks, resulting in a considerable ease of regulations and a vast opening of social facilities (e.g., theatres, cinemas, clubs etc.) for those fully vaccinated, negatively tested or with officially confirmed recuperation and previously state-mandatory remote work was not state regulated any longer.However, it is noteworthy that throughout October, case-numbers and the number of severe cases had already started to rise again -possibly increasing worries about new regulations or even a lockdown especially towards end of October or beginning of November.

Scales of socio-demographic measures
Age, Sex (male, female, divers), Education (no graduation/lower secondary/middle secondary/upper secondary/post-secondary non-tertiary/ Bachelor, Master, Doctoral or equivalent), Urban (or rural) living (large city, suburb of a large city, medium-sized city, small town, rural area), Minors living in the same household (yes/no), Pre-pandemic mhc (yes/no), Get social welfare (yes/no), Financial worries (not at all, somewhat, moderate, much, extreme).

Table A1 .
Wilcoxon-signed rank test comparing emotions and worries of adults with pre-pandemic mhc from pre-pandemic values (2020) until summer/autumn

Table A2 .
Wilcoxon-signed rank test comparing emotions and worries of adults without pre-pandemic mhc from pre-pandemic values (2020) until

Table A3 .
Latent profile analysis fit indices.

Table A4 .
Model fit and odds ratio (OR) with 95%t confidence intervals (CI) of multinomial logistic regression